Every day I experience life in the world of healthcare IT, supporting 3000 doctors, 18000 faculty, and 3 million patients. In this blog I record my experiences with infrastructure, applications, policies, management, and governance as well as muse on such topics such as reducing our carbon footprint, standardizing data in healthcare, and living life to its fullest.

Wednesday, April 9, 2014

Google Glass - the Details

I’m now able to publicly write about the work that Beth Israel Deaconess Medical Center has been doing with stealthy start up, Wearable Intelligence. We’ve been working over the past 4 months on pilots that I believe will improve the safety, quality and efficiency of patient care through the integration of wearable technology such as Google Glass in the hospital environment. I believe that wearable tech enables providers to deliver better clinical care by supporting them with contextually-relevant data and decision support wisdom.

One of our Emergency Department physicians, Dr. Steve Horng, said it best:

"Over the past 3 months, I have been using Google Glass clinically while working in the Emergency Department. This user experience has been fundamentally different than our previous experiences with Tablets and Smartphones. As a wearable device that is always on and ready, it has remarkably streamlined clinical workflows that involve information gathering.

For example, I was paged emergently to one of our resuscitation bays to take care of a patient who was having a massive brain bleed. One of the management priorities for brain bleeds is to quickly control blood pressure to slow down progression of the bleed. All he could tell us was that he had severe allergic reactions to blood pressure medications, but couldn’t remember their names, but that it was all in the computer.

Unfortunately, this scenario is not unusual. Patients in extremis are often unable to provide information as they normally would. We must often assess and mitigate life threats before having fully reviewed a patient’s previous history. Google Glass enabled me to view this patient’s allergy information and current medication regimen without having to excuse myself to login to a computer, or even loose eye contact. It turned out that he was also on blood thinners that needed to be emergently reversed. By having this information readily available at the bedside, we were able to quickly start both antihypertensive therapy and reversal medications for his blood thinners, treatments that if delayed could lead to permanent disability and even death. I believe the ability to access and confirm clinical information at the bedside is one of the strongest features of Google Glass.”

As procedure oriented specialists, emergency medicine clinicians must stay visually engaged with their patients while also using their hands to complete critical tasks. Wearing a device that enables clinicians to view different forms of information without having to disrupt workflow to access a computing device is empowering.

When a clinician walks into an emergency department troom, he or she looks at bar code (a QR or Quick Response code) placed on the wall. Wearable Intelligence’s software running on Google Glass immediately recognizes the room and then the ED Dashboard sends information about the patient in that room to the glasses, appearing in the clinician’s field of vision. The clinician can speak with the patient, examine the patient, and perform procedures while seeing problems, vital signs, lab results and other data.

Beyond the technical challenges of bringing wearable computers to BIDMC, we had other concerns—protecting security, evaluating patient reaction, and ensuring clinician usability.

We have fully integrated with the ED Dashboard using a custom application to ensure secure communication and the same privacy safeguards as our existing web interface. All data stays within the BIDMC firewall.

Wearable Intelligence has designed a custom user interface to take advantage of the Glass’ unique features such as gestures (single tap, double tap, 1 and 2 finger swipes, etc.), scrolling by looking up/down, camera to use QR codes, and voice commands. Information displays also needed to be simplified and re-organized.

We implemented real-time voice dictation of pages to staff members to facilitate communication among clinicians.

After several months of testing, we have deployed the product to clinical providers in the ED and are completing the first IRB approved study (to our knowledge) of the technology’s impact on clinical medicine.

Working on novel technology with Wearable Intelligence provides respite from an agenda that has been filled with meaningful use, ICD-10, ACA, and the HIPAA Omnibus rule. I look forward to reporting further about our experience.

Inspiring! My company Healium is working on a similar solution for the ED that connects to commercial EMRs, so your work is very validating. I recently wrote a blog post entitled "Slow Death by EMR or: How I Learned to Stop Clicking and Love Google Glass", about the generally poor clinical usability of most EMRs, and the potential to ameliorate this using wearables coupled with good human factors engineering.

Very exciting! While I am a huge supporter of EMRs my provider types on her computer and doesn't face me while doing my history. She has the option of sitting at a table and facing me but she doesn't. I've make faces and half laughed during physicals. So a Google glass type app might help her.

Awesome video from Wearable Intelligence! Glad to hear your project had IRB approval. I would be interested to hear how you designed it as a clinical trial. I wonder about Google now that they have a Technology Ethics Board, after acquiring Deepmind, if they ever need to be consulted on any kind of health technology assessment using novel clinical applications?